US News recently wrote an article regarding PTSD in veterans, where Dr. Rand McClain was given the opportunity to speak to 1 very exciting new treatment option: Ketamine infusions.
As discussed in other articles, there are different ways people attempt to treat PTSD. Earlier this year, the FDA approved a nasal spray made from ketamine. This spray is called Esketamine (Spravato). It’s said to improve symptoms of depression and PTSD.
In the past, Ketamine was used on the battlefields of the Vietnam war as an anesthesia medicine. In contrast, it was also abused as a party/club drug. According to WebMD, it takes over a chemical receptor, which can lower pain, help sedatives work, and if misused, can cause hallucinations and memory loss.
Twenty years ago, doctors experimented with an “off label” version of ketamine to treat depression in clinics and found success. Similarly, the FDA approved nasal spray can be used to treat these same symptoms in supervised, certified medical facilities.
If depression and PTSD are not the same, how can ketamine be used to treat both? Well, traditional antidepressants work to increase serotonin levels over time. Ketamine acts differently. It targets a stimulating neurotransmitter called glutamate and lessens its signal to the brain. The effects of this can be seen significantly faster than traditional antidepressants. This can be shown in research done by the National Institute of Mental Health.
Because PTSD isn’t all mental but physical as well, its treatment must be the same. “PTSD is definitely not all cognitive. You’re at a higher state of alert all the time,” explains Dr. McClain. “It’s very visceral.” This is where ketamine comes into play. It helps the patient detach from the symptoms, like fear, and see it without the emotional burden. By doing this, the patient feels the PTSD less intensely.
When describing the effects of ketamine, Dr. McClain brings up an Etch-a-Sketch. When you shake the board and erase it, that replicates how the ketamine infusion works. It can erase the pain felt from PTSD. But without a new mindset, you’ll end up drawing the same picture. That’s why Dr. McClain believes ketamine is most successful when used with cognitive-behavioral therapy, or CBT.
With its past as a club drug, it’s no wonder the medical community is taking precautions to keep ketamine’s use safe. The treatment cost helps scare away recreational users. A session of the medical IV treatment runs anywhere from $300 to $800. It’s also recommended that patients do six sessions to start. The nasal spray can cost up to $7,000.
The treatment also contains less than a typical abuser would use. “There’s a meticulous screening process to ensure it might benefit the patient, and treatments are supervised by medical professionals,” Dr. McClain says. “We’re using a controlled dose— usually a half milligram per kilogram of bodyweight—infused over roughly 40 minutes.”
A ketamine treatment with Dr. McClain is not some intimidating situation. You sit in a room attached to an IV and with your blood pressure monitored by nurses or a physician’s assistant. The environment is comfortable, you lay back in a chair and wear headphones. These headphones can be noise canceling or play music of your choice. You receive an infusion for 40 minutes, then steady yourself for another 20 minutes. After that, a friend or relative drives you home.
While some people may feel “healed” after one session, Dr. McClain shares that it is much more common for repeat treatments. “Normally, they do six treatments over the course of two or three weeks. After that, patients may come back to ‘top up’ every three to four weeks.”
While ketamine has worked wonders for some people, it’s not for everyone. If you have been diagnosed with schizophrenia, are a recreational user of psychedelics, or have uncontrolled hypertension, you should stay away from ketamine treatments.
Dr. Rand McClain was interviewed on this topic for an article by HealthCentral. He also discusses a variety of different topics on his website.